Some hospitals may strategically divert ambulances to avoid treating low paying patients who are uninsure or who have Medicaid, according to a recent analysis. Charleen Hsuan, assistant professor of health policy and administration at Penn State, led a study that examine whether hospitals are more likely to temporarily close their emergency departments to ambulances a process known as “ambulance diversion” if neighboring hospitals were public instead of private.

Hospitals are also diverting

The results recently publish in the journal Health Services Research find that hospitals may be more likely to start diverting ambulances if nearby public, rather than private, hospitals are also diverting. Diversions act as a release valve. Once an emergency department has declare a diversion, others in the area are likely to follow, said Hsuan. When hospitals declare an ambulance diversion, a vulnerable population may be extraordinarily disadvantaged.

Previous research suggests that minorities and people with low income are particularly affect by such ambulance diversions. According to the researchers, people who live in areas with restrict access to care are more likely to be affect. However, they may not realize it because in most cases, patients may not know they are being divert to a hospital that is farther away.

For their analysis, Hsuan and colleagues examine inpatient and emergency department discharge data from California’s Office of Statewide Health Planning and Development data from California in 2007 examining only complete hospital diversions. The sample include 28 private hospitals, which were match to 16 public hospitals of similar size and driving distance.

Neighboring public hospital

The researchers found that hospitals were about 3.6% more likely to start diverting ambulances; so if a nearby diverting hospital was public instead of private. In total, there were 6,516 diversions that happen after a neighboring public hospital start diverting. According to the researchers, 263 of these diversions may not have occur if the neighboring diverting hospital had been private instead of public.

Hsuan said the idea for the study came from a conversation; so she had with an emergency physician at a public hospital; so who share with her that every time the hospital; called for an ambulance diversion, hospitals surrounding the area would also call for one. Hsuan sought to find out what predictors may come into play for multiple hospitals; so to declare a diversion at the same time. There is a need for more research on the issue to help local, state; also federal authorities learn and work toward improving factors influencing such diversions,” according to Hsuan.